Pseudociesis. Reporte de caso / Psedocyesis. Case report

Introducción: Según el DSM-V, la pseudociesis se incluye en la categoría "otros síntomas somáticos específicos y trastornos relacionados" y se define como la falsa creencia de estar embarazada que se asocia con signos objetivos y síntomas de embarazo. La confirmación de la pseudociesis se consigue con un resultado negativo de la gonadotropina coriónica humana beta en la sangre y/o la orina asociado a un hallazgo ecográfico negativo. Materiales y métodos: se presenta el caso de mujer con síntomas y signos de embarazo que corresponden a pseudociesis, la paciente siguió creyendo que estaba embarazada debido a sus síntomas, a pesar de que las pruebas de embarazo dieron negativo. Conclusión: La pseudociesis es una enfermedad poco frecuente que a menudo se asocia a otras comorbilidades psiquiátricas y diagnósticos diferenciales poco claros. Es necesario la realización de más estudios, incluyendo series de casos y revisiones sistemáticas para comprender mejor esta infrecuente condición y sus otras variantes.

Introduction: According to the DSM-V, pseudocyesis is included in the category "other specific somatic symptoms and related disorders" and is defined as a false belief of being pregnant that is associated with objective signs and symptoms of pregnancy. Confirmation of pseudocyesis is achieved with a negative blood and/or urine beta-human chorionic gonadotropin result and a negative ultrasound finding. Materials and methods: We present a case of a woman with symptoms and signs of pregnancy corresponding to pseudocyesis, the patient continued to believe she was pregnant because of her symptoms, despite negative pregnancy tests. Conclusion: Pseudocyesis is a rare condition that is often associated with other psychiatric comorbidities and unclear differential diagnoses. Further studies, including case series and systematic reviews, are needed to better understand this rare condition and its other variants.

Disminución de la debilidad muscular adquirida en una unidad de cuidados intensivos con la implementación de un protocolo multicomponente: ensayo clínico cuasiexperimental / Decrease in the intensive care unit-acquired weakness with a multicomponent protocol implementation: A quasi-experimental clinical trial

Introducción. La debilidad adquirida en las unidades de cuidados intensivos es una complicación frecuente de los pacientes con enfermedades críticas, que puede tener un impacto negativo en su pronóstico a corto y a largo plazo. Objetivos. Evaluar si la utilización de un protocolo multicomponente, que incluye movilidad activa temprana, manejo efectivo del dolor, reducción de la sedación, medidas no farmacológicas para prevenir el delirium, estimulación cognitiva y apoyo familiar, puede disminuir la incidencia de debilidad adquirida en las unidades de cuidados intensivos al momento del egreso del paciente. Materiales y métodos. Se trata de un ensayo clínico, no aleatorizado, en dos unidades de cuidados intensivos mixtas de un hospital de tercer nivel. Los participantes fueron pacientes mayores de 14 años con ventilación mecánica invasiva por más de 48 horas. Se aplicó como intervención un protocolo multicomponente y como control se utilizó el cuidado usual o estándar. Resultados. Ingresaron 188 pacientes al estudio, 82 al grupo de intervención y 106 al grupo control. La tasa de debilidad adquirida en las unidades de cuidados intensivos al egreso de la unidad fue significativamente menor en el grupo de intervención (41,3 % versus 78,9 %, p<0,00001). La mediana del puntaje de movilidad al momento del alta de la unidad de cuidados intensivos fue mayor en el grupo de intervención (3,5 versus 2, p<0,0138). No se encontraron diferencias estadísticamente significativas en las medianas de días libres de respiración mecánica asistida, ni de unidad de cuidados intensivos al día 28, tampoco en la tasa de mortalidad general al egreso del hospital (18 versus 15 días, p<0,49; 18,2 % versus 27,3 %, p<0,167). Conclusiones. Un protocolo multicomponente que incluía movilidad activa temprana tuvo un impacto significativo en la reducción de la debilidad adquirida en las unidades de cuidados intensivos al egreso en comparación con el cuidado estándar.

Introduction. Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. Objectives. To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. Materials and methods. We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention -the multicomponent protocol- during intensive care hospitalization versus the standard care. Results. We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). Conclusion. A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.

Control de síntomas al final de la vida con Dexmedetomidina: Estudio observacional de centro único / End-of-life symptom control with dexmedetomidine: A single-center observational study

Introducción: El manejo de los síntomas refractarios con dexmetomidina (DXM) es una alternativa en pacientes oncológicos en la atención al final de la vida (AFV) lo que puede convertirse en un gran desafío, ante la necesidad de iniciar sedación paliativa. El objetivo del presente estudio es determinar el efecto de la DXM comparado con el midazolam (MDZ) en el control de síntomas refractarios en pacientes con cáncer avanzado AFV, como parte de una estrategia asistencial de sedación paliativa. Metodología: Estudio observacional, longitudinal, se revisaron los informes médicos en las historias clínicas de pacientes hospitalizados con diagnóstico de cáncer avanzado terminal y síntomas refractarios (dolor, disnea y delirio), que recibieron sedación paliativa con DXM o MDZ. Se utilizaron los registros de Escala de Evaluación de Síntomas de Edmonton - revisada (ESAS-r) para intensidad de síntomas y la Escala de Sedación/Agitación de Richmond (RASS) para respuesta a la sedación. Resultados: Un total de 35 pacientes recibieron DXM y 18 MDZ. El dolor (32 %) y delirio (30 %) fueron los síntomas refractarios más identificados. Dolor intenso en 89.3 % antes del inicio de DXM. A las 72 horas, el grupo DXM presentó disminución de la intensidad del delirio a leve y moderado, mientras que la mayoría de los pacientes del grupo MDZ fallecieron antes de las 72 horas. Conclusiones: El uso clínico de la DXM permite un enfoque multimodal, ampliando su utilidad en la atención al final de la vida para el manejo del dolor y delirio, ya que permite un estado de respuesta para la interacción con los miembros de la familia, función relevante en cuidados paliativos.

Introduction: Managing refractory symptoms with dexmedetomidine (DXM) is an alternative for cancer patients in end-of-life care (EOLC), which can become a great challenge, given the need to start palliative sedation. This study aims to determine the effect of DXM compared to midazolam (MDZ) in controlling refractory symptoms in patients with advanced EOLC cancer as part of a palliative sedation care strategy. Methodology: In this observational, longitudinal study, the medical reports in the medical records of hospitalized patients diagnosed with terminal advanced cancer and refractory symptoms (pain, dyspnea, and delirium) who received palliative sedation with DXM or MDZ were reviewed. The Edmonton Symptom Assessment Scale-revised (ESAS-r) scores for symptom intensity and the Richmond Sedation/Agitation Scale (RASS) for response to sedation were used. Results: A total of 35 patients received DXM, and 18 received MDZ. Pain (32%) and delirium (30%) were the most identified refractory symptoms. Intense pain in 89.3% before DXM started; at 72 hours in 64.3%, the pain was reported as mild. Delirium was severe in 77.7%, DXM was used in 59.3%, and MDZ was used in 40.7%. At 72 hours, the DXM group presented a decrease in delirium intensity to mild and moderate, while most of the patients in the MDZ group died before 72 hours. Conclusions: The clinical use of DXM allows a multimodal approach, expanding its usefulness in end-of-life care for managing pain and delirium since it provides a state of response for interaction with family members, a function relevant in palliative care.

Síndrome de Anton-Babinsky / Anton-Babinski Syndrome

Introducción: El síndrome de Anton-Babinsky es un trastorno neuropsiquiátrico poco frecuente, que se manifiesta por anosognosia y ceguera cortical, debido a lesiones en las áreas visuales asociativas de la corteza occipital sin presentar afectación en la vía visual. En adultos mayores sus manifestaciones clínicas suelen ser atípicas y la valoración geriátrica integral permite orientar el diagnóstico, que se puede asociar con síndromes geriátricos. Objetivo: Describir las manifestaciones clínicas, síndromes geriátricos, paraclínicos y tratamiento de un paciente con Síndrome de Anton-Babinsky. Caso clínico: Paciente de 85 años, quien durante un postoperatorio inmediato de cirugía ocular (pterigión) presentó alteración fluctuante del estado de conciencia, alucinaciones visuales, disminución de la agudeza visual bilateral y anosognosia. La analítica sanguínea no reportó alteraciones y la tomografía computarizada de cráneo documentó isquemia occipital bilateral, se le diagnosticó síndrome de Anton-Babinsky. Conclusiones: El síndrome de Anton-Babinsky puede tener presentación atípica a través de síndromes geriátricos. La valoración geriátrica integral permite realizar un diagnóstico y manejo multicomponente oportuno con el objetivo de influir en el pronóstico tanto a corto como a largo plazo(AU)

Introduction: Anton-Babinski syndrome is a rare neuropsychiatric disorder, with a manifestation of anosognosia and cortical blindness, due to lesions in the associative visual areas of the occipital cortex without presenting visual pathway impairment. In elderly adults, its clinical manifestations are usually atypical and a comprehensive geriatric assessment allows to guide the diagnosis, which can be associated with geriatric syndromes. Objective: To describe the clinical manifestations, geriatric syndromes, paraclinical findings and treatment of a patient with Anton-Babinski syndrome. Clinical case: This is the case of an 85-year-old patient who, during the immediate postoperative period after ocular surgery (pterygium), presented a fluctuating alteration of consciousness, visual hallucinations, decreased bilateral visual acuity and anosognosia. Blood analysis reported no alterations and cranial computed tomography documented bilateral occipital ischemia; the patient was diagnosed with Anton-Babinski syndrome. Conclusions: Anton-Babinski syndrome may have an atypical presentation through geriatric syndromes. Comprehensive geriatric assessment allows for timely multicomponent diagnosis and management with the aim of influencing both short- and long-term prognosis(AU)

Cuidados intensivos de enfermagem ao idoso com delirium: um protocolo de revisão de escopo / Intensive nursing care to older adults with delirium: a protocol of scoping review

OBJETIVO: explorar sistematicamente a literatura quanto aos cuidados de enfermagem prestados aos idosos internados com delirium, em unidades de terapia intensiva, sejam eles para prevenção, sejam eles para manejo do delirium. MÉTODO: protocolo de revisão de escopo, estruturado pelas recomendações do Manual do Instituto Joanna Briggs, utilizando as seguintes bases de dados: PubMed via MEDLINE, Scopus, Embase, Web of Science e Google Scholar. A bibliografia encontrada será organizada através do gerenciador EndNote. Após a exclusão dos estudos duplicados, as citações serão transferidas para o software Rayyan. Em seguida, será iniciada a triagem das referências por dois pesquisadores independentes. O processo da seleção de estudos será exibido no fluxograma adaptado do Checklist PRISMA-ScR. Os dados serão extraídos dos estudos através de uma planilha desenvolvida no programa Microsoft Excel pelos próprios autores, avaliando e interpretando as informações de acordo com o objetivo proposto. Os dados serão organizados em tabelas, quadros e fluxogramas, com discussão narrativa.

OBJECTIVE: to systematically explore the literature regarding the nursing care provided to the older adult hospitalized with delirium in intensive care units for the prevention or management of delirium. METHOD: scoping review protocol, structured by the recommendations of the Joanna Briggs Institute manual, utilizing the following database: MEDLINE via PubMed, Scopus, Embase, Web of Science, and Google Scholar. We will organize the citations found through the EndNote manager. After the exclusion of duplicated studies, we will transfer the citations to the Rayyan software. Afterward, two independent researchers will begin the screening of titles / abstracts. We will present the selection process of studies in the Checklist PRISMA-ScR adopted flowchart. The authors will extract the data of the studies through a spreadsheet developed in the Microsoft Excel, evaluating and interpreting the information according to the objective of the study. We will organize the data in charts, tables, and flowcharts with a narrative discussion.

Effect of seasons on delirium in postoperative critically ill patients: a retrospective analysis

Abstract Background and objectives Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations. Methods We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables. Results Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p= 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p= 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p= 0.002) than in winter. Conclusions In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.

Detección y barreras de medición del delirium en cuidado crítico: una revisión de alcance / Detecção e barreiras de mensuração do delirium em terapia intensiva: uma revisão de escopo / Detection and measurement barriers of delirium in the Intensive Care Unit: A scoping review

Objetivo: identificar las estrategias de enfermería para la detección de delirium y las barreras para su medición en la unidad de cuidado intensivo. Materiales y método: revisión de alcance a partir de la metodología del Instituto Joanna Briggs y el protocolo PRISMA-ScR, mediante una búsqueda en seis bases de datos con los términos "delirium", "diagnosis", "nursing", "critical care" y "critical care nursing" y la extracción del software SUMARI. Resultados: se seleccionaron 43 estudios para análisis y categorización en dos temáticas emergentes: "Herramientas de uso frecuente para la detección del delirium" y "Barreras reportadas por el personal de enfermería para la evaluación del delirium". Conclusiones: existe una gran variedad de herramientas validadas y estandarizadas para la detección del delirium en cuidado intensivo. No obstante, su uso es limitado en muchas ocasiones debido a las distintas barreras del paciente, el personal evaluador y el equipo multidisciplinar. Por ello, resulta importante entrenar al personal de salud para que esté familiarizado con el delirium, su detección y el uso de los múltiples instrumentos disponibles.

Objetivo: identificar as estratégias de enfermagem para detectar o delirium e as barreiras para sua mensuração na unidade de terapia intensiva. Materiais e método: revisão de escopo que seguiu a metodologia do Instituto Joanna Briggs e o protocolo Prisma-ScR, com busca em seis bases de dados, com os termos "delirium", "diagnosis", "nursing", "critical care" e "critical care nursing", e a extração no software SUMARI. Resultados: foram selecionados 43 estudos para a análise e categorização dos temas emergentes: "ferramentas de uso frequente para a detecção do delirium" e "barreiras apresentadas pela equipe de enfermagem para a avaliação do delirium". Conclusões: existe uma grande variedade de ferramentas validadas e padronizadas disponíveis para a detecção do delirium em terapia intensiva, no entanto seu uso é muitas vezes limitado devido às diferentes barreiras tanto do paciente quanto da equipe avaliadora e da equipe multidisciplinar. Por isso, é importante capacitar os profissionais de saúde para que se familiarizem com o delirium, sua detecção e o uso dos múltiplos instrumentos disponíveis.

Objective: To identify nursing strategies for the detection of delirium and the existing barriers for measuring this condition in the Intensive Care Unit. Materials and method: Scoping review following the Joanna Briggs Institute methodology and the PRISMA-ScR protocol through a research in six databases ­with the terms "delirium", "diagnosis", "nursing", "critical care", and "critical care nursing"­ and extraction in SUMARI software. Results: Forty-three studies were selected for analysis and categorization into two emerging themes: "Frequently used tools for delirium screening" and "Barriers by nursing staff for the evaluation of delirium". Conclusions: There is a wide variety of validated and standardized tools for the detection of delirium in intensive care. However, their use is often limited due to different barriers experienced by the patient, the evaluating staff, and the multidisciplinary team. Therefore, it is important to train health personnel so that they are familiar with delirium, its detection, and the use of the available instruments.

Impacto do delirium ocorrido na uti no tratamento oncológico a curto e longo prazo / Impact of delirium in intensive care unit on short and long term oncological treatment

Introdução: Delirium é uma síndrome neurocognitiva de início agudo e curso flutuante. A incidência de delirium em pacientes oncológicos varia de 25% a 40%. Em pacientes internados em terapia intensiva, o desenvolvimento do delirium está associado ao aumento do tempo em ventilação mecânica, do tempo de internação na UTI e no hospital e da mortalidade. Em sobreviventes, o delirium está associado à piora funcional e cognitiva, que podem levar a mudanças na proposta de tratamento em pacientes com câncer. Objetivo: Avaliar se ocorrência de delirium durante a internação na UTI associou-se a mudança na proposta do tratamento oncológico em pacientes que sobreviveram à internação hospitalar, em comparação com aqueles que não tiveram delirium. Métodos: Estudo de coorte, retrospectivo, com pacientes com funcionalidade preservada e proposta de tratamento oncológico internados na UTI no período de janeiro de 2015 a dezembro de 2018. Foi considerado que o delirium estava presente se o Confusion Assessment Method for Intensive Care Unit (CAM-ICU) fosse positivo. Foi avaliada a associação entre o delirium e a modificação do tratamento após a alta e realizada análise de mediação para avaliar a influência direta e indireta (ou seja, mediada pela piora da funcionalidade) do delirium na mudança do tratamento oncológico. Por fim, foi avaliada a associação entre mudança de tratamento e mortalidade em 1 ano. Resultados: Foram incluídos 1134 pacientes, dos quais 189 (16,7%) apresentaram delirium. O delirium foi associado à mudança de tratamento oncológico (OR = 3,80; IC 95%, 2,72 a 5,35), após ajuste para idade, sexo, funcionalidade, comorbidades e gravidade à admissão. A associação entre delirium na UTI e mudança de tratamento foi direta e mediada pela piora do status de desempenho. A proporção do efeito total do delirium na mudança de tratamento mediada pela piora do status de desempenho foi de 33,0% (IC 95%, 21,7 a 46,0). A mudança de tratamento associou-se a maior mortalidade em 1 ano (OR = 2,68; IC 95%, 2,01 a 3,60), após ajuste para idade, sexo, comorbidades, gravidade à admissão, delirium, uso de ventilação mecânica, terapia de substituição renal durante a internação e funcionalidade após a alta. Conclusão: Os pacientes que apresentaram delirium durante a internação na UTI tiveram uma taxa mais elevada de mudança do tratamento oncológico após a alta. O efeito do delirium na mudança de tratamento oncológico foi apenas parcialmente mediado pela piora da funcionalidade. A mudança de tratamento associou-se a maior mortalidade em 1 ano

Introduction: Delirium is a neurocognitive syndrome with acute course and fluctuating duration. The incidence of delirium in oncology patients ranges from 25% to 40%. In intensive care patients, the development of delirium is associated with increased time on mechanical ventilation, ICU and hospital length of stay, and mortality. In survivors, delirium is associated with functional and cognitive decline, which may lead to changes in treatment proposal in cancer patients. Objective: To evaluate whether there was immediate and delayed change in oncology treatment proposal in patients who had delirium during ICU admission but survived hospital admission, compared with those who did not have delirium. Methods: This was a retrospective cohort study of patients with preserved functionality and proposed oncology treatment admitted to the ICU from January 2015 to December 2018. We considered delirium present if Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was positive We assessed the association between delirium and modification of the treatment after discharge. We also performed a mediation analysis to assess both the direct and indirect (ie, mediated by worsening of performance status) of delirium on discontinuation of cancer treatment. Finally, we assessed whether change in cancer treatment was associated with one-year mortality. Results: We included 1134 patients, of which 189 (16.7%) had delirium. Delirium was associated with changing cancer treatment (OR = 3.80; 95% CI, 2.72 to 5.35), after adjusting for age, sex, comorbidities and severity at admission. The association between ICU delirium and treatment change was direct and mediated by worsening performance status. The proportion of the total effect of delirium on treatment change mediated by worsening performance status was 33.0% (95% CI, 21.7 to 46.0). Change in treatment wa associated with one-year mortality (OR = 2.68; IC 95%, 2.01 to 3,60) after adjusting for age, sex, comorbidities, severity at admission, delirium, mechanical ventilation and renal replacement therapy during ICU stay. Conclusion: Patients who experienced delirium during their ICU stay had a higher rate of oncologic treatment change after discharge. The effect of delirium on changing cancer treatment was only partially mediated by worsening functionality.Change in treatment was associated with one-year mortality

Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore

INTRODUCTION@#Post-anaesthesia care unit (PACU) delirium affects 5%-45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable, but it remains under-recognised due to a lack of awareness of its diagnosis. The nursing delirium screening scale (Nu-DESC) has been validated for diagnosing PACU delirium, but is not routinely used locally. This study aimed to use Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population.@*METHODS@#We conducted an audit of eligible patients undergoing major surgery in three public hospitals in Singapore over 1 week. Patients were assessed for delirium 30-60 min following their arrival in PACU using Nu-DESC, with a total score of ≥2 indicative of delirium.@*RESULTS@#A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%), and the incidence was 9/146 (6.2%) in patients aged > 65 years. Post-anaesthesia care unit delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic regression analysis showed that the use of bispectral index (P < 0.001) and the presence of malignancy (P < 0.001) were significantly associated with a higher incidence of PACU delirium.@*CONCLUSION@#In this first local study, the incidence of PACU delirium was 3.8%, increasing to 6.2% in those aged > 65 years. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long-term morbidities and mortality in PACU delirium.

Correlation between malnutrition and delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation / 中华危重病急救医学

OBJECTIVE@#To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation.@*METHODS@#A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled. The confusion assessment method (CAM) was used to evaluate the delirium of the patients in intensive care unit (ICU). The score of CAM ≥ 1 was defined as delirium. Mini nutritional assessment short-form (MNA-SF) was used to assess the nutritional status of patients, and MNA-SF score ≤ 7 was defined as malnutrition. Patients were divided into delirium group and non-delirium group according to whether delirium occurred. The differences in clinical indicators, length of ICU stay, duration of mechanical ventilation and wake-up time after drug withdrawal were compared between the two groups. After 28 days of short-term follow-up, the patients were divided into death group and survival group, and the differences in the incidence of delirium and malnutrition between the two groups were compared. Binary multivariate Logistic regression analysis was used to screen the risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. Kaplan-Meier survival curve was used to analyze the effect of delirium on prognosis.@*RESULTS@#A total of 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation were enrolled, of whom 98 survived and 34 died within 28 days, with a mortality of 25.76%. The incidence of malnutrition and delirium in the death group was significantly higher than that in the survival group (61.76% vs. 37.76%, 64.71% vs. 26.53%, both P < 0.05), and the MNA-SF score was significantly lower than that in the survival group (6.32±1.80 vs. 8.72±2.23, P < 0.01). Procalcitonin (PCT), interleukin-6 (IL-6) and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group [PCT (μg/L): 4.47 (2.69, 10.39) vs. 2.77 (1.28, 5.94), IL-6 (ng/L): 204.08 (126.12, 509.85) vs. 120.46 (60.67, 290.99), Lac (mmol/L): 5.14 (2.75, 8.60) vs. 3.13 (2.16, 4.30), all P < 0.05], and the wake-up time after drug withdrawal was significantly longer than that in the survival group (minutes: 33.94±8.51 vs. 28.92±7.03, P < 0.01). Among 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation, 48 patients had delirium during ICU stay, and 84 patients did not have delirium. The incidence of delirium was 36.36%. The 28-day mortality in the delirium group was significantly higher than that in the non-delirium group (45.83% vs. 14.29%, P < 0.01), and the MNA-SF score was significantly lower than that in the non-delirium group (6.46±1.77 vs. 9.05±2.15, P < 0.01), the length of ICU stay, duration of mechanical ventilation, and wake-up time after drug withdrawal were also significantly longer than those in the non-delirium group [length of ICU stay (days): 13.40±9.59 vs. 10.06±7.81, duration of mechanical ventilation (hours): 197.06±89.80 vs. 138.81±82.30, wake-up time after drug withdrawal (minutes): 35.85±7.01 vs. 26.99±6.12, all P < 0.05]. Binary multivariate Logistic regression analysis showed that malnutrition [odds ratio (OR) = 7.527, 95% confidence interval (95%CI) was 2.585-21.917], Lac (OR = 5.345, 95%CI was 1.733-16.483), wake-up time after drug withdrawal (OR = 6.653, 95%CI was 2.021-21.904) were independent risk factors for delirium during ICU stay in elderly patients with severe pneumonia undergoing invasive mechanical ventilation (all P < 0.01). Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate of patients in the delirium group was significantly lower than that in the non-delirium group (54.17% vs. 85.71%), and the difference was statistically significant (Log-Rank test: χ2 = 16.780, P < 0.001).@*CONCLUSIONS@#The risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation during ICU stay include malnutrition, Lac, and wake-up time after drug withdrawal. The occurrence of delirium is closely related to poor prognosis.

Expert consensus on late stage of critical care management / 中华内科杂志

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.

Hospital admission and the occurrence of delirium in older adults with physical frailty: cross-sectional study / Ingreso hospitalario y aparición de delirio en adultos mayores con fragilidad física: estudio transversal / Internação hospitalar e a ocorrência de delirium em idosos na condição de fragilidade física: estudo transversal

ABSTRACT Objective To analyze the relationship between hospitalization and the occurrence of delirium in older adults with physical frailty. Method Cross-sectional study carried out in a public hospital in southern Brazil. Hospitalized older adults aged ≥ 60 years participated. Sociodemographic and clinical data were collected, physical frailty phenotype tests were performed and the Confusion Assessment Method was used. Descriptive analyzes were carried out and odds ratio values were estimated for the frailty and delirium variables. Results Of the 320 older adults evaluated, 21.14% presented delirium, 49% were identified as pre-frail and 36.2% as frail. Of those affected by delirium, 71.6% were classified as frail and 28.3% as pre-frail (p < 0.001). An association was observed between the occurrence of delirium and frailty (OR 1.22; 95% CI 1.07 to 1.38), age ≥ 80 years (OR 1.14; 95% CI 1.01 to 1.32), epilepsy (OR 1.38; 95% CI 1.09 to 1.76), dementia (OR 1.58; 95% CI 1.37 to 1.82), and history of stroke (OR 1.14; 95% CI 1.03 to 1.26). Conclusion There was a high frequency of pre-frail and frail older adults, and the occurrence of delirium in frail was significantly higher. Special attention should be paid to frail older adults to prevent the occurrence of delirium during hospitalization.

RESUMEN Objetivo Analizar la relación entre la hospitalización y la aparición de delirio en adultos mayores con fragilidad física. Método Estudio transversal realizado en un hospital público del sur de Brasil. Participaron adultos mayores hospitalizados con edad ≥ 60 años. Se recogieron datos sociodemográficos y clínicos, se realizaron pruebas de fenotipo de fragilidad física y se utilizó el Confusion Assessment Method. Se realizaron análisis descriptivos y se estimaron los odds ratio para las variables fragilidad y delirio. Resultados De los 320 adultos mayores evaluados, el 21,14% presentó delirio, el 49% fueron identificados como prefrágiles y el 36,2% como frágiles. De los adultos mayores afectados por delirio, el 71,6% fueron clasificados como frágiles y el 28,3% como prefrágiles (p < 0,001). Se observó asociación entre la aparición de delirio y fragilidad (OR 1,22; IC 95% 1,07 a 1,38), edad ≥ 80 años (OR 1,14; IC 95% 1,01 a 1,32), epilepsia (OR 1,38; IC 95% 1,09 a 1,76), demencia (OR 1,58; IC del 95%: 1,37 a 1,82) y antecedentes de accidente cerebrovascular (OR 1,14; IC del 95%: 1,03 a 1,26). Conclusión Hubo una alta frecuencia de adultos mayores prefrágiles y frágiles y la aparición de delirio en los frágiles fue significativamente mayor. Se debe prestar especial atención a los adultos mayores frágiles para prevenir la aparición de delirio durante la hospitalización.

RESUMO Objetivo Analisar a relação entre hospitalização e ocorrência de delirium em idosos na condição de fragilidade física. Método Estudo transversal desenvolvido em hospital público no Sul do Brasil. Participaram idosos hospitalizados, idade ≥ 60 anos. Foram coletados dados sociodemográficos e clínicos, e feitos testes do fenótipo da fragilidade física, bem como o Confusion Assessment Method. Realizaram-se análises descritivas e estimaram-se as odds ratio para as variáveis fragilidade e delirium. Resultados Dos 320 idosos avaliados, 21,14% apresentaram delirium, 49% foram identificados como pré-frágeis e 36,2% frágeis. Dos idosos acometidos por delirium, 71,6% foram classificados como frágeis e 28,3% pré-frágeis (p< 0,001). Observou-se associação entre ocorrência de delirium e fragilidade (OR 1,22; IC 95% 1,07 a 1,38), idade ≥ 80 anos (OR 1,14; IC 95% 1,01 a 1,32), epilepsia (OR 1,38; IC 95% 1,09 a 1,76), demência (OR 1,58; IC 95% 1,37 a 1,82), e história de acidente vascular encefálico (OR 1,14; IC 95% 1,03 a 1,26). Conclusão Observou-se alta frequência de idosos pré-frágeis e frágeis e ocorrência de delirium expressivamente maior nos frágeis. Atenção especial deve ser empregada a idosos frágeis para prevenir a ocorrência de delirium durante a hospitalização.

Proposição do mnemônico DELIRIUM+ para otimização do ensino e assistência clínica relacionadas ao delirium / DELIRIUM+ as a mnemonic device to optimize delirium-related teaching and clinical care

Delirium, a common neurocognitive disorder among hospitalized older adults, depends on an interrelationship between precipitating and predisposing factors. Adequate prevention, detection, and management are directly related to knowledge of these factors. Due to a lack of education, delirium is underdiagnosed and the time taken to identify and react to the condition is suboptimal. Based on an open review of the literature, the main precipitating factors were compiled into the acronym DELIRIUM, in Portuguese. A second acronym MAIS (meaning 'plus') was compiled from important behaviors for preventing and treating delirium. Thus, the mnemonic device DELIRUM+ stands for: Discomfort, Electrolytes/metabolism, Locale/environment, Infections, urinary/fecal Retention; and acute clinical complIcations; Uremia; Medications + (Mobility, Assistant/companion, Interactions, and Sleep/psychotropic substances]. This mnemonic device can encourage teaching and care aimed at the prevention, detection, and management of delirium. Ideally, the clinical impact of this mnemonic device should be tested in research to validate its implementation. (AU)

Delirium é um distúrbio neurocognitivo frequente entre idosos hospitalizados e depende da interrelação entre fatores precipitantes e predisponentes. Sua adequada prevenção, detecção e seu manejo estão diretamente relacionados ao conhecimento desses fatores. Devido à baixa disseminação de ensino nessa área, o delirium é subdiagnosticado e o tempo de identificação e instituição de condutas é subótimo. A partir de revisão aberta da literatura, os principais fatores precipitantes foram listados e compilados em categorias nominadas, em português, com as letras que compõem a palavra DELIRIUM. O símbolo de mais (+) foi acrescido para destacar condutas que deveriam ser mais bem observadas para a prevenção e o manejo do delirium, utilizando-se as letras que compõem a palavra MAIS. Resultados: Apresenta-se proposição do mnemônico DELIRIUM+: D or; E letrólitos/Metabólico; L ocal/ambiente; I nfecções/invasões; R etenção urinária/fecal; I ntercorrência clínica aguda; U remia; M edicamentos; + [M obilidade; A companhante; I nteração; S ono]. A proposição desse mnemônico tem potencial para favorecer o ensino e a assistência voltados à prevenção, à detecção e ao manejo do delirium. Idealmente, o real impacto clínico desse mnemônico deverá ser testado em delineamento de pesquisa para validar sua implementação. (AU)

Definición, diagnóstico del delirium en Unidades de Cuidado Intensivo: una revisión paraguas / Definition, diagnosis of delirium in Intensive Care Units: an umbrella review

INTRODUCCIÓN: El delirium es un desorden cognitivo propio de la enfermedad crítica, está vinculado al aumento de la mortalidad, mayor estadía hospitalaria, mayores requerimientos de UCI, mayor deterioro funcional y necesidad de unidades de rehabilitación y cuidados crónicos. OBJETIVO: Identificar y evaluar la evidencia de los últimos 5 años respecto a definición y diagnóstico del delirium en adultos hospitalizados en UCI por medio de una revisión de revisiones sistemáticas y metaanálisis. MATERIALES Y MÉTODOS: Una revisión Umbrella guiada según guías del JBI. Los datos fueron obtenidos Science direct, Web of Science, Scielo, CINAHL, PubMed, Biblioteca Virtual de Salud (BVS) y Biblioteca Cochrane. La última búsqueda fue realizada el 28 de marzo de 2022. RESULTADOS: Catorce revisiones cumplieron los criterios de inclusión, la definición de delirium desde la perspectiva de pacientes y familia, prevalencia factores de riesgo y precisión de las diferentes escalas como CAM-ICU, ICDSC, PREDELIRIC y E-PREDILIRC tienen buenos valores predictivos. CONCLUSIONES: El delirium hipoactivo posee mayor prevalencia e incidencia en las UCI. Es necesario que el personal de salud adopte ciertas actitudes con el paciente con delirium.

INTRODUCTION: Delirium is a cognitive disorder typical of critical illness, it is linked to increased mortality, longer hospital stay, higher ICU requirements, greater functional impairment and the need for rehabilitation and chronic care units. OBJECTIVE: To identify and evaluate the evidence of the last 5 years regarding the definition and diagnosis of delirium in adults hospitalized in the ICU through a review of systematic reviews and meta-analyses. MATERIALS AND METHODS: An Umbrella review guided by JBI guidelines. Data were obtained from Science direct, Web of science, Scielo, CINAHL, PubMed, Virtual Health Library (VHL) and Cochrane Library. The last search was carried out on March 28, 2022. RESULTS: Fourteen reviews met the inclusion criteria, the definition of delirium from the perspective of patients and families, prevalence of risk factors and accuracy of the different scales such as CAM-ICU, ICDSC, PREDELIRIC and E-PREDILIRC have good predictive values. CONCLUSIONS: Hypoactive delirium has a higher prevalence and incidence in ICUs. It is necessary that the health personnel adopt certain attitudes with the patient with delirium.

Internação hospitalar e a ocorrência de delirium em idosos na condição de fragilidade física: estudo transversal / Hospitalization and the occurrence of delirium in physically frail older adults: a cross-sectional study

Resumo: Trata-se de estudo quantitativo de corte transversal, que objetivou analisar a relação entre internação hospitalar e ocorrência de delirium em idosos na condição de fragilidade. Este estudo integra o projeto de pesquisa intitulado "Fragilidade física e os desfechos clínicos, funcionais, nutricionais e a demanda de cuidados em idosos hospitalizados", aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos do Setor de Ciências da Saúde da Universidade Federal do Paraná, parecer no 4.985.540 e pelo Comitê de Ética em Pesquisa em Seres Humanos da Secretaria Municipal de Saúde de Curitiba, parecer no 5.055.260. O estudo foi desenvolvido no Hospital Municipal do Idoso Zilda Arns, Curitiba, Paraná. Os participantes foram idosos, com idade = 60 anos, hospitalizados para tratamento clínico e/ou cirúrgico nas unidades de internação. Calculou-se o tamanho mínimo da amostra (n=300 idosos) utilizando-se o período pré-pandêmico, ano de 2019, como recorte temporal, no qual ocorreram 7.254 internações, sendo 4.146 = 60 anos. Os dados foram coletados por meio de questionários sociodemográfico e clínico e testes que compreendem o fenótipo da fragilidade física e o Confusion Assessement Method no período de março a julho de 2022. Realizaram-se análises descritivas para as variáveis sociodemográficas, internação, laboratoriais, histórico médico e estimaram-se as odds ratio ajustadas para as variáveis fragilidade e delirium. Dos 320 idosos avaliados, o delirium foi evidenciado em 67 (21,14%) no momento da admissão. Houve predomínio de idosos pré-frágeis (n=157; 49%), seguidos dos frágeis (n=116; 36,25%) e não frágeis (n=44; 13,75%). A proporção de idosos frágeis que apresentaram delirium foi de 71,64% e entre os pré frágeis 28,36% (p<0,0001). O modelo preditivo indicou associação entre a ocorrência de delirium e fragilidade (OR 1,22; IC95% 1,07 a 1,38), idade > 80 anos (OR 1,14; IC95% 1,01 a 1,32), diagnóstico de epilepsia (OR 1,38; IC95% 1,09 a 1,76) e diagnóstico de demência (OR 1,58; IC95% 1,37 a 1,82). Outrossim, encontrou-se associação entre a ocorrência de delirium e valores de Proteína C-Reativa acima dos valores de referência (OR 3,13; IC95% 1,10 a 11,36) e história prévia de acidente vascular encefálico (OR 1,14; IC95% 1,03 a 1,26). Durante a internação hospitalar, idosos frágeis mostraram maior probabilidade de desenvolverem delirium. Pré-fragilidade e fragilidade foram condições prevalentes no ambiente hospitalar, tornando-se importante seu rastreio e gerenciamento durante o internamento. Houve maior propensão ao desenvolvimento de delirium em idosos acima de 80 anos. Medidas de prevenção ao delirium devem ser implementadas nessa faixa etária minimizando-se as consequências deletérias. Destaca-se a importância da realização de anamnese que busque a identificação do diagnóstico de demência, epilepsia e acidente vascular encefálico prévio para ampliar as medidas de prevenção do delirium pela equipe multiprofissional.

Abstract: This is quantitative and cross-sectional study whose objective was to analyze the relationship between hospitalization and occurrence of delirium in frail older adults. This study is part of the research project entitled "Physical frailty, clinical, functional and nutritional outcomes and care demand in hospitalized older adults", approved by the Committee of Ethics in Research with Human Beings from the Health Sciences Sector of the Federal University of Paraná with opinion No. 4,985,540, and by its counterpart belonging to the Curitiba Municipal Health Department with opinion No.5,055,260. The study was developed in the Zilda Arns Municipal Hospital for Older Adults, Curitiba, Paraná. The participants were older adults aged = 60 years old and admitted for clinical and/or surgical treatment in the hospitalization units. Sample size (n=300 older adults) was calculated considering the pre-pandemic period (2019) as time frame, in which there were 7,254 hospitalizations, with 4,146 patients aged = 60 years old. The data were collected by means of sociodemographic and clinical questionnaires and of tests that include the physical frailty phenotype and the Confusion Assessment Method from march to July 2022. Descriptive analyses were performed for the sociodemographic, hospitalization, laboratory and medical history variables, and the adjusted odds ratios were estimated for the frailty and delirium variables. Among the 320 older adults evaluated, delirium was evidenced in 67 (21.14%) at admission. There was predominance of pre-frail aged individuals (n=157; 49%), followed by frail (n=116; 36.25%) and non-frail (n=44; 13.75%). The percentage of frail older adults that presented delirium was 71.64% and, for the prefrail, it was 28.36% (p<0.0001). The predictive model indicated an association between occurrence of delirium and frailty (OR: 1.22; 95%CI: 1.07-1.38), age > 80 years old (OR: 1.14; 95%CI: 1.01-1.32), epilepsy diagnosis (OR: 1.38; 95%CI: 1.09-1.76) and dementia diagnosis (OR: 1.58; 95%CI: 1.37-1.82). Furthermore, an association was also found between occurrence of delirium and Reactive C Protein above the reference values (OR: 3.13; 95%CI: 1.10-11.36) and previous stroke history (OR: 1.14; 95%CI: 1.03-1.26). During hospitalization, frail older adults were more likely to develop delirium. Pre-frailty and frailty were prevalent conditions in the hospital environment, with their screening and management becoming important during hospitalization. Propensity to develop delirium was higher in older adults aged over 80 years old. Measures to prevent delirium should be implemented in this age group, minimizing the deleterious consequences. The importance of performing anamnesis seeking to identify previous dementia, epilepsy and stroke diagnoses is emphasized, in order to expand the measures to prevent delirium by the multiprofessional team.

The plague: a case of delusional infestation with folie à deux / A praga: um caso de delírio de infestação com folie à deux

Folie à deux or Shared psychotic disorder (SPD) is a rare condition characterized by shared psychotic symptoms between two or more individuals. Delusional parasitosis (DP) is an uncommon psychiatric illness in that patients believe they are infested by insects, without evidence to support this belief. DP occurs in 5­15% of SPD. We report a case of cutaneous DP with SPD between an elderly mother and a daughter that lived together and withdrew from other social contacts for the last three years. We aim to highlight the relationship between SPD and DP, its prognosis, and clinical implications.

Folie à deux ou Perturbação Psicótica Compartilhada (PPC) é uma condição rara caracterizada por sintomas psicóticos compartilhados entre dois ou mais indivíduos. O delírio parasitário (DP) é uma doença psiquiátrica incomum em que os pacientes acreditam estar infestados por insetos, sem evidências que sustentem essa crença. O DP ocorre em 5 a 15% das PPC. Relatamos um caso de um DP cutâneo com PPC entre uma mãe idosa e uma filha que viviam juntas e afastadas de outros contatos sociais nos últimos três anos. O nosso objetivo é destacar a relação entre PPC e o DP, o seu prognóstico e implicações clínicas

Enfermeiros e as práticas recomendadas no manejo de delirium: estudo transversal / Enfermeras y mejores prácticas en el manejo del delirio: estudio transversal / Nurses and the best practices in the management of delirium: cross-sectional study

Objetivos:descrever a concordância dos enfermeiros quanto à avaliação, diagnóstico e prevenção de delirium em uma Unidade de Terapia Intensiva e verificar a associação da concordância ao perfil sociodemográfico dos profissionais. Método:estudo transversal realizado nas Unidades de Terapia Intensiva geral e cardiológica de um hospital de alta complexidade, entre janeiro e fevereiro de 2018. Participaram 61 enfermeiros por meio de surveyeletrônica com dezessete questões, sendo excluídos os que estavam em férias ou licença médica durante a coleta de dados. Resultados:A mediana de afirmativas com alta concordância foi de 11 por profissional, com 64% da amostra obtendo baixa concordância. As afirmativas com melhor concordância incluíram fatores de risco, algoritmo de avaliação, atuação do enfermeiro e conhecimento sobre sinais da síndrome. Conclusão:Os enfermeiros apresentaram baixa concordância às diretrizes de melhores práticas no manejo do delirium e não foi encontrada associação entre a alta concordância e ascaracterísticas sociodemográficas

Objectives:to describe nurses' agreement to regarding the assessment, diagnosis and preventionof delirium in the Intensive Care Unit and to verify the association of agreement with the sociodemographic profile of professionals. Method:cross-sectional study carried out in the general and cardiac Intensive Care Units of a high-complexity hospital, between January and February 2018. Sixty one nurses participated in an electronic survey with seventeen questions, excluding those who were on vacation or sick leave during the data collection. Results:The median of statements with high agreement was 11 per professional, with 64% of the sample obtaining low agreement. The statements with the best agreement included risk factors, assessment algorithm, nurse's role and knowledge about signs of the syndrome. Conclusion:Nurses showed low agreement with the guidelines for best practices in the management of delirium and no association was found between high agreement and sociodemographic characteristics.

Objetivos:describir la concordancia de enfermeras sobre la evaluación, diagnóstico y prevencióndel delirio en la Unidad de Cuidados Intensivos y verificar la asociación de concordancia con el perfil sociodemográfico de los profesionales. Método:estudio transversal realizado en las Unidades de Cuidados Intensivos Generales y Cardíacos de un hospital de alta complejidad, entre enero y febrero de 2018. Participaron 61 enfermeras en una encuesta electrónica con diecisiete preguntas, excluyendo a las que se encontraban de vacaciones o baja laboral durante la recopilación de datos. Resultados:La mediana de enunciados con alta concordancia fue de 11 por profesional, con un 64% de la muestra obteniendo baja concordancia. Los enunciados con mejor concordancia incluyeron factores de riesgo, algoritmo de evaluación, rol de la enfermera y conocimiento sobre los signos del síndrome. Conclusión:las enfermeras mostraron bajo acuerdo con las guías de buenas prácticas en el manejo del delirio y no se encontró asociación entre alto acuerdo y características sociodemográficas

Sospecha de delirium y posibles factores relacionados en el adulto mayor hospitalizado / Suspeita de delírio e possíveis fatores relacionados em idosos internados / Suspected delirium and possible related factors in hospitalized older adults

Objetivo: describir la sospecha de delirium en adultos mayores hospitalizados en medicina interna y sus posibles factores relacionados. Materiales y método: estudio correlacional de corte transversal y muestreo por conveniencia, con 49 adultos mayores de 70 años hospitalizados en medicina interna que aceptaron participar de forma voluntaria. Se aplicó la Escala de Detección de Delirium por Enfermería, la cual mide la sospecha de delirium, y se empleó análisis descriptivo y bivariado. Resultados: la prevalencia de sospecha de delirium en los pacientes del estudio fue de 20,4 %. La edad fue significativamente menor en los pacientes que no presentaron delirium en comparación con aquellos que mostraron sospecha (73 vs. 82 años, respectivamente, p = 0,05). Otras variables que evidenciaron un comportamiento similar son el número de comorbilidades (1 sin delirium vs. 2 sospecha, p = 0,037), haber padecido delirium al menos una vez antes de la actual hospitalización (1 sin delirium vs. 6 sospecha, p = 0,000) y no reportar antecedentes psicoactivos (17 sin delirium vs. 3 sospecha p = 0,009). El análisis bivariado evidenció una posible asociación significativa entre el delirium y los antecedentes de diabetes (or 6,8; ic 95 % 1,43-32,19 [p = 0,020]), el consumo de alcohol (or 5,2; ic 95 % 1,15-23,85 [p = 0,029]) y antecedentes de delirium en hospitalización previa (or 6,3; ic 95 % 1,02-38,9 [p = 0,000]). Conclusiones: el delirium es un problema que continúa impactando a los adultos, particularmente a los adultos mayores, quienes por los factores fisiológicos propios de la edad son más vulnerables a padecer este evento.

Objective: To describe the suspicion of delirium in older adults hospitalized in internal medicine and the possible risk factors associated to this event. Materials and method: Cross-sectional and correlational study through convenience sampling. Forty-nine adults over 70 years hospitalized in internal medicine agreed to participate by signing an informed consent form. We adopted the Nursing Delirium Screening Scale, which measures suspicion of delirium. Descriptive and bivariate analysis was also used.Results: The prevalence of suspected delirium among participants was 20.4%. Age was significantly lower in patients who did not present delirium compared to those who showed suspicion (73 vs. 82 years, respectively, p = 0.05). Other variables that showed a similar behavior were the number of comorbidities (1 no delirium vs. 2 suspected, p = 0.037), having suffered from delirium at least once before current hospitalization (1 no delirium vs. 6 suspected, p = 0.000), and no psychoactive history (17 no delirium vs. 3 suspected, p = 0.009). Bivariate analysis reported a possible significant association between delirium and history of diabetes (or 6.8; ci 95% 1.43-32.19 [p = 0.020]), alcohol consumption (or 5.2; ci 95% 1.15-23.85 [p = 0.029]), and history of delirium during previous hospitalization (or 6.3; ci 95% 1.02 - 38.9 [p = 0.000]). Conclusions: Delirium is an issue that continues to affect adults, particularly the elderly, who are more vulnerable to suffering this event due to age-related physi-ological factors.

Objetivo: descrever suspeitas de delírio em idosos internados em medicina interna e os seus possíveis fatores de risco. Materiais e método: estudo correlacional de corte transversal com amostragem por conveniência. Participaram 49 pessoas com mais de 70 anos de idade internadas em medicina interna que concordaram em participar de forma voluntária. Foi utilizada a Escala de Detecção do Delírio para Enfermagem, que mede as suspeitas de delírio. Foi utilizada uma análise descritiva e bivariada. Resultados: a prevalência de suspeita de delírio no estudo foi de 20,4%. A idade era significativamente mais baixa naqueles que não apresentavam delírio em comparação com aqueles que apresentavam suspeitas (73 vs 82 anos, respectivamente, p = 0,05). Outras variáveis mostraram comportamento semelhante, tais como número de comorbilidades (1 sem delírio vs 2 suspeitas, p = 0,037), tendo sofrido de delírio pelo menos uma vez antes da internação atual (1 sem delírio vs 6 suspeitas, p = 0,000) e nenhum histórico psicoativo (17 sem delírio vs 3 suspeitas, p = 0,009). A análise bivariada evidenciou uma possível associação significativa entre delírio e histórico de diabetes (or 6,8 ci 95% 1,43-32,19 [p = 0,020]), consumo de álcool (or 5,2 ci 95% 1,15-23,85 [p = 0,029]) e histórico de delírio em internação anterior (or 6,3 ci 95% 1,02-38,9 [p = 0,000]). Conclusões: o delírio é um problema que continua a ter impacto nos adultos, mais ainda na população idosa, que, devido a fatores fisiológicos relacionados com a idade, são mais vulneráveis a sofrer com esse evento.

O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico / The nurse's role in preventing delirium in critically ill adult/elderly patients

Introdução: Delirium é uma disfunção cerebral aguda, associado ao aumento da mortalidade e morbilidade, que atinge frequentemente o paciente adulto/idoso crítico. O enfermeiro tem um papel determinante na prevenção/controlo do delirium, através da implementação de intervenções não farmacológicas. Objetivo: Conhecer as intervenções de enfermagem na identificação, prevenção e controlo do delirium no paciente adulto/idoso crítico. Materiais e métodos: Realizada uma Revisão Integrativa da Literatura de artigos publicados entre 2014 e 2018, que identificaram intervenções de enfermagem dirigidas à prevenção e controlo do delirium no paciente adulto/idoso crítico. Foram realizadas quatro pesquisas, nas bases de dados electrónicas da EBSCOhost e na B-on. Resultados: Identificaram-se 13 estudos, que apresentam intervenções de enfermagem, maioritariamente não farmacológicas, para prevenção e controlo do delirium no paciente adulto/idoso crítico. Destas, evidenciam-se intervenções relacionadas com o ambiente, promoção do sono, intervenção terapêutica precoce, avaliação cognitiva e orientação dos pacientes, intervenções sistematizadas em protocolos, bem como intervenções direcionadas à participação dos familiares, à formação dos enfermeiros e ao ensino dos pacientes. Foram também identificados fatores de risco para o desenvolvimento do delirium e instrumentos de avaliação. Discussão: A prevenção do delirium é importante e imperativa, já que nos pacientes críticos a sua ocorrência está associada ao aumento da mortalidade, morbilidade, do tempo de internamento e a um elevado custo hospitalar. A identificação dos fatores de risco para a ocorrência do delirium devem estar incluídos nos protocolos de abordagem do delirium. Conclusão: As evidências demonstraram que o enfermeiro é fundamental na identificação precoce, prevenção e controlo do delirium, evitando a progressão da doença, contribuindo para a diminuição da morbilidade e mortalidade. A intervenção de enfermagem deve incluir a identificação de fatores predisponentes e/ou precipitantes de modo a contribuir para a diminuição da ocorrência e/ou resolução do quadro de delirium.

Introduction: Delirium is an acute brain dysfunction, associated with increased mortality and morbidity, which often affects critically ill adult/elderly patients. Nurses have a crucial role in the prevention/control of delirium, through the implementation of non-pharmacological interventions. Objective: To know the nursing interventions in the identification, prevention and control of delirium in adult/critical elderly patients. Materials and Methods: An Integrative Literature Review of articles published between 2014 and 2018 was carried out, which identified nursing interventions aimed at the prevention and control of delirium in adult/critical elderly patients. Four searches were carried out, in the electronic databases of EBSCOhost and B-on. Results: 13 studies were identified, which present nursing interventions, mostly non-pharmacological, for the prevention and control of delirium in adult/critical elderly patients. Of these, interventions related to the environment, sleep promotion, early therapeutic intervention, cognitive assessment and patient orientation, interventions systematized in protocols, as well as interventions aimed at the participation of family members, the training of nurses and the teaching of patients are evident. Risk factors for the development of delirium and assessment tools were also identified. Discussion: The prevention of delirium is important and imperative, since its occurrence in critically ill patients is associated with increased mortality, morbidity, length of stay and a high hospital cost. The identification of risk factors for the occurrence of delirium should be included in delirium management protocols. Conclusions: Evidence has shown that nurses are essential in the early identification, prevention and control of delirium, preventing the progression of the disease, contributing to the reduction of morbidity and mortality. The nursing intervention must include the identification of predisposing and/or precipitating factors to contribute to the reduction of the occurrence and/or resolution of delirium.

Introducción: El delirio es una disfunción cerebral aguda, asociada con un aumento de la mortalidad y la morbilidad, que afecta con frecuencia a pacientes adultos/ancianos críticamente enfermos. Las enfermeras tienen un papel crucial en la prevención/control del delirio, a través de la implementación de intervenciones no farmacológicas. Objetivo: Conocer las intervenciones de enfermería en la identificación, prevención y control del delirio en pacientes adultos/ancianos críticos. Materiales y métodos: Se realizó una Revisión Integrativa de la Literatura de artículos publicados entre 2014 y 2018, que identificaron intervenciones de enfermería dirigidas a la prevención y control del delirio en pacientes adultos/ancianos críticos. Se realizaron cuatro búsquedas, en las bases de datos electrónicas de EBSCOhost y B-on. Resultados: Se identificaron 13 estudios que presentan intervenciones de enfermería, en su mayoría no farmacológicas, para la prevención y control del delirio en pacientes adultos/ancianos críticos. De estas, se evidencian intervenciones relacionadas con el medio ambiente, la promoción del sueño, la intervención terapéutica temprana, la evaluación cognitiva y la orientación del paciente, intervenciones sistematizadas en protocolos, así como intervenciones dirigidas a la participación de los familiares, la formación de enfermeras y la enseñanza de los pacientes. También se identificaron factores de riesgo para el desarrollo de delirio y herramientas de evaluación. Discusión: La prevención del delirio es importante e imperativa, ya que su ocurrencia en pacientes críticos se asocia con aumento de la mortalidad, morbilidad, estancia hospitalaria y alto costo hospitalario. La identificación de factores de riesgo para la aparición de delirio debe incluirse en los protocolos de manejo del delirio. Conclusión: La evidencia ha demostrado que los enfermeros son esenciales en la identificación temprana, prevención y control del delirio, previniendo la progresión de la enfermedad, contribuyendo para la reducción de la morbimortalidad. La intervención de enfermería debe incluir la identificación de factores predisponentes y/o precipitantes para contribuir a la reducción de la ocurrencia y/o resolución del delirio.

Delirium, catatonía y síndrome de abstinencia manifestados como agitación psicomotora en COVID-19: una propuesta de manejo farmacológico en el hospital general / Delirium, catatonia and substance withdrawal syndrome manifested as psychomotor agitation in COVID-19: a pharmacological management approach for the general hospital setting

BACKGROUND: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. AIM: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. MATERIAL AND METHODS: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. CONCLUSIONS: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.